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					                     Midwives in Private Practice


Submission to the

Nursing and Midwifery Board of Australia



by email:
‘Attention: Anne Copeland, Chair, Nursing and Midwifery Board of Australia’
natboards@dhs.vic.gov.au




Dear Ms Copeland

Please find attached the submission by Midwives in Private Practice (MiPP), in
response to the Consultation paper on registration standards and related
matters issued by the Nursing and Midwifery Board of Australia.

We are happy to provide further information or evidence if you request it.

Yours truly,




Joyce Isabella Johnston
Registered Midwife, Division 1.
Registration Number: 31427, Nurses Board of Victoria.




MIPP, C/- 25 Eley Rd, Blackburn South Vic 3130 Tel: 03 9808 9614
MIPP is a Participating Organisation in Maternity Coalition
Introduction:
Midwives in Private Practice (MiPP) is a collective of midwives, representing the
majority of privately practising midwives in Victoria, who are also the responsible
professional attendants at the majority of homebirths in this State. We are members
of the Australian College of Midwives (ACM), Maternity Coalition, and Australian
Private Midwives Association (APMA).
We recognise and use the International definition of the Midwife (ICM 2005 –
Attachment 1) as a reliable statement of our scope of practice and our general
professional boundaries. This definition has been foundational in describing
midwifery practice and in guiding midwifery education for many years, and its
principles are embedded in Australian midwifery codes and education. The previous
version of the ICM definition (1990) was quoted in the Code of Practice for Midwives
in Victoria (NBV 1996).
We endorse the APMA Position Statement on Planned Home Births with a Midwife
(Attachment 2).
MiPP is focused on the safety of women and their babies in the childbearing-early
parenting continuum, and the ability of Australian women to access quality midwifery
care.
MiPP supports women’s choice in maternity options within a framework of quality and
safety.
MiPP supports all women being able to access midwives as primary maternity carers,
and employ midwives privately, in all professional care settings, including the
woman’s own home.
MiPP calls on the new Nursing and Midwifery Board of Australia to promote changes
in the statutory regulation of the midwifery profession that will improve safety and
effectiveness of maternity care for all women.
We draw your attention to evidence of consistently exemplary outcomes from the
maternity care provided by privately practising midwives in Victoria, as reported by
the Health Department’s Perinatal Data Collection Unit (PDCU 2008) over many
years, and in other professional publications (Parratt and Johnston 2002). Recent
Performance Indicator analysis of all planned homebirths in Victoria in the past five
years has also demonstrated excellent outcomes
(http://midwivesvictoria.blogspot.com/2009/10/more-irrefutable-evidence-of-safety-
in.html).
Current legislation before the Federal and State Parliaments will impact greatly on
midwives in private practice. We implore the National Nursing and Midwifery Board
to ensure that the voices of midwives in private practice, and the women who employ
us, are heard at this time of major change.


2.3 Professional indemnity insurance
The standard requiring professional indemnity insurance as a condition of registration
can be fair and acceptable only if that product is accessible for all midwives to whom
it applies, at a reasonable cost. The statutory regulator is responsible for determining
who may and who may not practise midwifery. MiPP strongly objects to delegation of
the regulation of midwives to the insurance industry, in that the insurance industry
becomes the de facto decision maker. Furthermore, MiPP strongly objects to anti-
competitive practices supported by the Australian government, in providing
subsidised indemnity insurance for medical practitioners who provide primary
maternity care, without giving equal rights to subsidised indemnity products for
midwives who provide the same service.


3 Proposals for board- specific standards
MiPP objects strongly to the introduction of a new category of midwife, namely
‘midwife practitioner’. All midwives are practitioners of midwifery, and the word
‘practitioner’ should only be an adjective when referring to midwives, and not part of a
protected title.
The midwifery profession does not support there being a category of registration
called ‘midwife practitioner’. The midwife’s scope of practice is generally limited to
the childbearing continuum and related clinical issues such as neonatal care and
aspects of gynaecology. It appears that the introduction of the title ‘midwife
practitioner’ into the legislation happened without consultation or due process.
Although NSW legislation has included a title ‘midwife practitioner’, this has not been
accepted or endorsed by the midwifery profession nationally or internationally, and
should be deleted from the legislation and from the Board’s standards.
All midwives are required, under the National Competency Standards for the Midwife
(ANMC 2006) to be competent in the practise of midwifery. Those midwives who are
employed in a limited practice area, such as a neonatal unit, are expected to
maintain competence across the scope of midwifery practice in order to retain their
midwifery qualification. It is unreasonable to establish titles and associated
standards, such as the ‘midwife practitioner’ title, which conflict with the embedded
competency standards for midwifery practice.
Midwives are strongly opposed to the proposal in the consultation paper that would
require endorsement as a midwife practitioner for a midwife seeking to provide MBS
funded services under the proposed Commonwealth reforms. Midwives providing
MBS funded care will have the same scope of practice as any other midwife.
The standard requiring that the qualification for endorsement as a midwife
practitioner “means a master’s degree” is inconsistent with any rational
understanding of a midwife’s qualification and scope of practice, and would de-value
the current midwifery qualification held by midwives in Australia.
There is no public protection in the introduction of a midwife practitioner qualification,
either with or without a master’s degree. One predictable impact this would have is
to drive homebirth underground, with increasing reliance on unregulated and
unqualified practitioners – the antithesis of public protection.
Another predictable impact of the restriction of the midwife’s scope of practice
through introduction of a ‘midwife practitioner’ protected title, with MBS funding
attached, is further unjustified costs to the sector of the community seeking the
services of privately practising midwives. The Board’s compliance with the Council of
Australian Government’s (COAG) guiding principles should ensure that there be no
“unnecessary regulatory burdens that would create unjustified costs for the sector or
the community.” (Consultation paper p18)


Endorsement in relation to scheduled medicines (midwives)
All midwives, by definition and by Australian standards, must be able to act on their
own authority in attending birth in any setting. This includes the diagnosis of post
partum haemorrhage and the decision to intervene medically by administering an
oxytocic, which is a scheduled drug. MiPP members are midwives who attend
planned homebirths. The practice of obtaining, possessing, supplying, and


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administering oxytocics in appropriate clinical situations is a fundamental aspect of
safe midwifery practice in the community. Any restriction of midwives’ access to
drugs which are essential for safe midwifery practice is against the public interest.


Education standards:
MiPP supports the national accreditation standards for midwifery published by the
ANMC in 2009 and recommend that these be endorsed by the Board. These
standards are historic in that they follow on more than 2 years of consultation with
key stakeholders, and represent a consensus view among the midwifery profession
and the regulators across Australia (as well as consumers).




References:
ANMC, 2006. National Competency Standards of the Midwife. Australian Nursing
     and Midwifery Council. http://www.anmc.org.au/professional_standards
ICM, 2005. Definition of a Midwife. International Confederation of Midwives
     http://www.internationalmidwives.org/Documentation/Coredocuments/tabid/322/
     Default.aspx
NVB 1996. Code of Practice for Midwives in Victoria. Nurses Board of Victoria.
Parratt J and Johnston J, 2002. Planned homebirths in Victoria, 1995-1998.
     Australian College of Midwives Journal Vol 15 No 2, pp16-25.
PDCU 2008. Homebirths 2006. Hospital Profile of Maternal and Perinatal Data.
     Victorian Government Department of Human Services.




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Attachment 1


Definition of the Midwife
A midwife is a person who, having been regularly admitted to a midwifery educational
programme, duly recognised in the country in which it is located, has successfully completed
the prescribed course of studies in midwifery and has acquired the requisite qualifications to
be registered and/or legally licensed to practise midwifery.

The midwife is recognised as a responsible and accountable professional who works in
partnership with women to give the necessary support, care and advice during pregnancy,
labour and the postpartum period, to conduct births on the midwife’s own responsibility and to
provide care for the newborn and the infant. This care includes preventative measures, the
promotion of normal birth, the detection of complications in mother and child, the accessing of
medical care or other appropriate assistance and the carrying out of emergency measures.

The midwife has an important task in health counselling and education, not only for the
woman, but also within the family and the community. This work should involve antenatal
education and preparation for parenthood and may extend to women’s health, sexual or
reproductive health and child care.

A midwife may practise in any setting including the home, community, hospitals, clinics or
health units.

Adopted by the International Confederation of Midwives Council meeting, 19th July, 2005,
Brisbane, Australia
Supersedes the ICM “Definition of the Midwife” 1972 and its amendments of 1990




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Attachment 2

APMA Position Statement on Planned Home Births
with a Midwife
Adopted by APMA:        29 October 2009

Introduction
Australian Private Midwives Association (APMA) represents the majority of privately practising
midwives in Australia, who are also the responsible professional attendants at the majority of
homebirths in this country. APMA aims, through representing private midwives at national
professional discussions, to support women through promoting and protecting continuity of
midwifery primary care. APMA is a key stakeholder in any professional discussion about
homebirth.

Many APMA members are active professionally in the Australian College of Midwives (ACM),
as well as in groups that establish partnership between midwives and consumers, such as
Australian Society of Independent Midwives, Midwives in Private Practice, Maternity Coalition,
Homebirth Australia, Home Midwifery Association (Qld), Homebirth Access Sydney (NSW),
Birth Matters (SA), and Birthing and Babies Support (BaBS).

The following statement represents the view of APMA on planned home births with a midwife.
APMA reserves the right to revise and update this Position Statement as time passes. APMA
encourages ACM and other stakeholder organisations to endorse this statement and adopt it
without change as their Position Statement on Home Births with a Midwife.




POSITION STATEMENT ON PLANNED HOME BIRTHS WITH A MIDWIFE

1.      We support home birth with a midwife in attendance for women who have
        uncomplicated labours.
        1.1      Midwives practising in any setting are responsible and accountable for their
                 decision making about their own scope of practice and referral and transfer
                 of care.
        1.2      We support the use of the National Midwifery Guidelines for Consultation
                 and Referral (ACM 2008) as a guide in midwifery referral decisions.

2.      We support and adopt the International Confederation of Midwives’ (ICM) Definition of
        the Midwife (2005) (attached below), which is foundational to all midwifery practice,
        including homebirth. The ICM Definition of the Midwife establishes the following
        principles which apply in this statement:
        2.1        The principle of ‘partnership’: “The midwife … works in partnership with
                   women …”
        2.2        The principle of professional responsibility: “The midwife is recognised as a
                   responsible and accountable professional …”
        2.3        The principle of continuity of carer (‘caseload’) – primary care: “The midwife
                   … works … to give the necessary support, care and advice during
                   pregnancy, labour and the postpartum period, …”
        2.4        The principle of primary care – on the midwife’s own responsibility: “… to
                   conduct births on the midwife’s own responsibility and to provide care for
                   the newborn and the infant.”
        2.5        The principle of health promotion: “This care includes preventative
                   measures, the promotion of normal birth,…”
        2.6        The principle of detection of complications, consultation, referral, and
                   carrying out emergency measures: “This care includes … the detection of
                   complications in mother and child, the accessing of medical care or other
                   appropriate assistance and the carrying out of emergency measures.”



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         2.7        The principle that midwifery care has broad community health implications:
                    “The midwife has an important task in health counselling and education, not
                    only for the woman, but also within the family and the community. This work
                    should involve antenatal education and preparation for parenthood and
                    may extend to women’s health, sexual or reproductive health and child
                    care.”
         2.8        The principle of ‘any setting’: “A midwife may practise in any setting
                    including the home, community, hospitals, clinics or health units.”

3.       We support the right of every woman to access a midwife as the primary maternity
         caregiver who works in partnership with the woman throughout the episode of care,
         who is able to be the responsible professional in attendance at the birth either at
         home or hospital, and who is able to make appropriate referral and transfer of care
         when required.
         3.1       We support a woman’s right to self-determination and control over her body
                   and her pregnancy, including the right to give birth in the place of her
                   choice.
         3.2       We support and value the woman’s ability to make informed decisions
                   about place of birth, and other choices as her pregnancy and labour
                   progress, in partnership with a known and trusted midwife of her choice.

4.       We support the right of a midwife to practise privately1 in a fee-for-service or funded
         relationship with the client, or to take up employment.

5.       We support only those regulatory restrictions that are able to pass the ‘public interest’
         test: “How does this promote health and wellbeing in the mother and baby?”2

6.       We support an expectation of equity, including equal pay for equal work throughout a
         midwife’s scope of practice. Midwives who provide primary maternity care are
         entitled to the same public funding, the same opportunity to charge a fee-for-service,
         the same access to hospital referral, and publicly supported indemnity insurance, as
         medical practitioners providing the same maternity services.3

7.       We support processes by which midwives are able to gain experience and mentoring
         in order to commence and demonstrate continuing competence in homebirth practice.

8.       We support seamless and reliable processes by which midwives are able to make
         hospital bookings for women planning homebirth, and arrange transfer to the hospital
         in a timely way when needed.




1
  Private practice models may include solo practice, group practice, or other schemes that are designed
to provide private midwifery services for women. This is a fair expectation for members of any
profession. This issue does not relate exclusively to homebirth practice. The midwife is ‘with
woman’, rather than being bound to any plan for birth.
2
  A position statement on midwifery practice for homebirth is NOT related to Medicare Eligible
criteria, which is a politically negotiated and managed matter about government funding, and does not
improve the standard of care for mother or baby. There is no public interest in restricting access of
women to midwives who are willing and able to provide care that includes the option of homebirth. On
the contrary, there is a likelihood that such restriction will result in harm.
3
  We do not support any monopoly of access to funding or hospital maternity services or professional
indemnity insurance that excludes all or some midwives.



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